Hospital Emergency Management Planning Exercises and Training Assignment

Hospital Emergency Management Planning Exercises and Training Assignment ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Hospital Emergency Management Planning Exercises and Training Assignment Can you help me understand this Health & Medical question? Hospital Emergency Management Planning Exercises and Training Assignment What are some of the biggest challenges in developing and implementing a preparedness exercise in a hospital setting? What differences/similarities exist between hospital and municipal preparedness exercises? Reilly, M., &Markenson, D. S. (2010). Health Care Emergency Management: Principles and Practice Chapter 6: Introduction to Exercise Design and Evaluation Chapter 8: Education and Training Emergency management principles and practices for healthcare systems (2006). assessing_hospital_disaster_preparedness.pdf DISASTER MEDICINE/ORIGINAL RESEARCH Assessing Hospital Disaster Preparedness: A Comparison of an On-Site Survey, Directly Observed Drill Performance, and Video Analysis of Teamwork Amy H. Kaji, MD, MPH Vinette Langford, RN, MSN Roger J. Lewis, MD, PhD From the Department of Emergency Medicine, Harbor–UCLA Medical Center, Los Angeles, CA (Kaji, Lewis); David Geffen School of Medicine at UCLA, Torrance, CA (Kaji, Lewis); Los Angeles Biomedical Research Institute, Torrance, CA (Kaji, Lewis); The South Bay Disaster Resource Center at Harbor–UCLA Medical Center, Los Angeles, CA (Kaji); and MedTeams and Healthcare Programs Training Development and Implementation, Dynamics Research Corporation, Andover, MA (Langford). Study objective: There is currently no validated method for assessing hospital disaster preparedness. We determine the degree of correlation between the results of 3 methods for assessing hospital disaster preparedness: administration of an on-site survey, drill observation using a structured evaluation tool, and video analysis of team performance in the hospital incident command center. Methods: This was a prospective, observational study conducted during a regional disaster drill, comparing the results from an on-site survey, a structured disaster drill evaluation tool, and a video analysis of teamwork, performed at 6 911-receiving hospitals in Los Angeles County, CA. The on-site survey was conducted separately from the drill and assessed hospital disaster plan structure, vendor agreements, modes of communication, medical and surgical supplies, involvement of law enforcement, mutual aid agreements with other facilities, drills and training, surge capacity, decontamination capability, and pharmaceutical stockpiles. The drill evaluation tool, developed by Johns Hopkins University under contract from the Agency for Healthcare Research and Quality, was used to assess various aspects of drill performance, such as the availability of the hospital disaster plan, the geographic configuration of the incident command center, whether drill participants were identifiable, whether the noise level interfered with effective communication, and how often key information (eg, number of available staffed floor, intensive care, and isolation beds; number of arriving victims; expected triage level of victims; number of potential discharges) was received by the incident command center. Teamwork behaviors in the incident command center were quantitatively assessed, using the MedTeams analysis of the video recordings obtained during the disaster drill. Spearman rank correlations of the results between pair-wise groupings of the 3 assessment methods were calculated. Results: The 3 evaluation methods demonstrated qualitatively different results with respect to each hospital’s level of disaster preparedness. The Spearman rank correlation coefficient between the results of the on-site survey and the video analysis of teamwork was – 0.34; between the results of the on-site survey and the structured drill evaluation tool, 0.15; and between the results of the video analysis and the drill evaluation tool, 0.82. Hospital Emergency Management Planning Exercises and Training Assignment Conclusion: The disparate results obtained from the 3 methods suggest that each measures distinct aspects of disaster preparedness, and perhaps no single method adequately characterizes overall hospital preparedness. [Ann Emerg Med. 2008;52:195-201.] 0196-0644/$-see front matter Copyright © 2008 by the American College of Emergency Physicians. doi:10.1016/j.annemergmed.2007.10.026 INTRODUCTION A disaster may be defined as a natural or manmade event that results in an imbalance between the supply and demand for resources.1 Events of September 11, 2001, and the devastation from Hurricanes Katrina and Rita have recently Volume ??, ??. ? : September ???? highlighted the importance of hospital disaster preparedness and response. Previous disasters have demonstrated weaknesses in hospital disaster management, including confusion over roles and responsibilities, poor communication, lack of planning, suboptimal training, and a Annals of Emergency Medicine 195 Assessing Hospital Disaster Preparedness Editor’s Capsule Summary What is already known on this topic Extremely little is known on how to objectively and accurately rate hospital disaster preparedness. Scales and measurements have been developed but not extensively validated; most evaluations are highly subjective and subject to bias. What question this study addressed At 6 sites, 3 evaluation methods, an onsite predrill survey, a real-time drill performance rating tool, and a video teamwork analysis, were used and correlations among evaluation methods examined. What this study adds to our knowledge The 3 methods produced disparate evaluations of preparedness, suggesting that the instruments are flawed, they are measuring different things, or both. How this might change clinical practice Better assessment tools for hospital disaster preparedness need to be developed, perhaps beginning with the careful definition of what aspects of preparedness are to be measured. lack of hospital integration into community disaster planning.2 Despite The Joint Commission’s emphasis on emergency preparedness for all hospitals, including requirements for having a written disaster plan and participating in disaster drills, there is currently no validated, standardized method for assessing hospital disaster preparedness. This lack of validated assessment methods may reflect the complex and multifaceted nature of hospital preparedness. To be prepared to care for an influx of victims, a hospital must have adequate supplies, equipment, and space, as well as the appropriate medical and nonmedical staff. Survey instruments, either self-administered or conducted on site, may be used to assess these resources. Although surveys and questionnaires attempt to capture a hospital’s level of preparedness through quantifying hospital beds, ventilators, isolation capacity, morgue space, available modes of communication, frequency of drills, and other aspects of disaster preparedness,3-8 it is unclear whether they are reliable or valid predictors of hospital performance during an actual disaster, or even during a drill. In contrast to surveys, which assess hospital resources and characteristics during a period of usual activity, disaster drills make use of moulaged victims to gauge hospital preparedness and assess staff interactions in a dynamic environment in real time. Although hospitals routinely conduct after-drill debriefing sessions, during which participants discuss deficiencies warranting improvement, there is no commonly used and 196 Annals of Emergency Medicine Kaji, Langford & Lewis validated method for evaluating hospital performance during disaster drills. Hospital Emergency Management Planning Exercises and Training Assignment To address this gap, the Johns Hopkins University Evidence-based Practice Center, with support from the Agency for Healthcare Research and Quality (AHRQ), developed a hospital disaster drill evaluation tool.9 The tool includes separate modules for the incident command center, triage area, decontamination zone, and treatment areas. In a recent study, conducted in parallel with the study reported here, we described the AHRQ evaluation tool’s internal and interrater reliability.10 We found a high degree of internal reliability in the instrument’s items but substantial variability in interrater reliability.10 Recently, evidence has suggested that enhancing teamwork among medical providers optimizes the provision of health care, especially in a stressful setting, and some experts working in this area have adopted the aviation model as a basis for designing teamwork programs to reduce medical errors.11 In 1998, researchers from MedTeams, a research corporation that focuses on observing and rating team behaviors, set out to evaluate the effectiveness of using aviation-based crew resource management programs to teach teamwork behaviors in emergency departments (EDs), conducting a prospective, multicenter, controlled study.12 The MedTeams study, published in 2002, demonstrated a statistically significant improvement in the quality of team behaviors, as well as a reduction in the clinical error rate, after completion of the Emergency Team Coordination Course.12 Because effective teamwork and communication are essential to achieving an organized disaster response, assessing teamwork behavior may be a key element in a comprehensive evaluation of hospital disaster response. Evaluating teamwork behaviors involves the assessment of the overall interpersonal climate, the ability of team members to plan and problem-solve, the degree of reciprocity among team members in giving and receiving information and assistance, the team’s ability to manage changing levels of workload, and the ability of the team to monitor and review its performance and improve its teamwork processes.12 In addition to observing team members in real time, MedTeams researchers routinely review videotaped interactions among team members as a method of quantifying teamwork behaviors. The objective of our study was to determine the degree of correlation between 3 measures of assessing hospital disaster preparedness: an on-site survey, directly observed drill performance, and video analysis of teamwork behaviors. MATERIALS AND METHODS Six 911-receiving hospitals, participating in the annual, statewide disaster drill in November 2005, agreed to complete the site survey and undergo the drill evaluation and video analysis. The selection of the sample of hospitals and their characteristics has been described previously.10 The drill scenario included an explosion at a public venue, with multiple victims. To preserve the anonymity of the hospitals, they are designated numerically 1 through 6. Because all data were Volume ??, ??. ? : September ???? Kaji, Langford & Lewis deidentified and reported in aggregate, our study was verified as exempt by the institutional review board of the Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center. We used an on-site survey (included in Appendix E1, available online at http://www.annemergmed.com), which included 79 items focusing on areas previously identified as standards or evidence of preparedness.1-3,13-28 The survey was a modification of an instrument we used in a previous study. Hospital Emergency Management Planning Exercises and Training Assignment 8 Compared with the original survey instrument, the number of items was reduced from 117 to 79 by the study investigators to eliminate items that had limited discriminatory capacity and to reduce redundancy and workload. Survey items included a description of the structure of the hospital disaster plan, modes of intra- and interhospital communication, decontamination capability and training, characteristics of drills, pharmaceutical stockpiles, and each facility’s surge capacity (assessed by monthly ED diversion status, number of available beds, ventilators, negative pressure isolation rooms, etc). Because a survey performed in 1994 demonstrated that hospitals were better prepared when the medical directors of the ED participated in community planning,27 we also assessed whether each hospital participated in the local disaster planning committee. Additional survey items examined mutual aid agreements with other hospitals and long-term care facilities; predisaster “preferred” agreements with medical vendors; protocols for canceling elective surgeries and early inpatient discharge; the ability to provide daycare for dependents of hospital staff; the existence of syndromic surveillance systems; ongoing training with local emergency medical services (EMS) and fire agencies; communication with the public health department; and protocols for instituting volunteer credentialing systems, hospital lockdown, and managing mass fatality incidents. The survey was distributed by electronic mail, and between June 2006 and June 2007, the disaster coordinators at each of the 6 hospitals completed the survey. The on-site “inspection” to verify the responses to the 79 item survey was performed by a single observer (A.H.K.) between June 2006 and June 2007. During the visit, necessary clarification of responses to the survey items was obtained, followed by an examination of the hospital disaster plan, the decontamination shower, the personal protective equipment, communication systems (eg, walkietalkies and radio system), Geiger counters, the ED, the laboratory, the pharmacy, and the designated site of the incident command center. The possible answers for 71 of the 79 survey items were assigned a point value. Depending on perceived importance, items were allocated zero to 1 point, zero to 3 points, or zero to 5 points, with a higher score indicating better preparedness. For example, for the question, how many patients could you treat for a nerve agent exposure? the answer “fewer than 10” would be given a score of zero, the answer “10 to 20” would be given a score of 1, “20 to 30” would be given a score of 2, and “greater Volume ??, ??. ? : September ???? Assessing Hospital Disaster Preparedness than 30” would be given a score of 3. There were also 8 of 79 questions to which no point value was assigned because the item was not designed to discriminate between levels of preparedness. For example, no point value was assigned to the question, have you ever had to truly implement the incident command structure? A summary score for overall preparedness was calculated by summing each of the item scores. The maximum possible score was 215 (see Appendix E1, available online at http://www.annemergmed.com). As described in our recent study and companion article evaluating the reliability of the drill evaluation tool, 32 trained medical student observers were deployed to the 6 participating hospitals to evaluate drill performance using the AHRQ instrument.9 Two hundred selected dichotomous drill evaluation items were coded as better versus poorer preparedness by the study investigators.10 An unweighted “raw performance” score was calculated by summing these dichotomous indicators. v Although the drill evaluation instrument assesses multiple areas of the hospital, including triage, decontamination, treatment, and incident command, we chose to consider only those items related to the performance of the incident command center because it was the only drill evaluation module that was applied at all 6 hospitals, as described in the companion article.10 Moreover, the MedTeams evaluation (see below) was based on video analysis of the incident command center. We also believed that a high level of performance in the incident command center would be correlated with high levels of performance elsewhere in the hospital. There were 45 dichotomous items evaluating the incident command center that could be dichotomously coded as indicating better or worse preparedness. Examples of drill evaluation items included whether the incident command center had a defined boundary zone, the incident commander took charge of the zone, the incident commander was easily identifiable, the hospital disaster plan was accessible, and whether the noise level in the incident command center interfered with effective communication. Because of the limited number of observers, 2 hospitals had 1 observer deployed to the incident command center, whereas 4 hospitals had 2 observers. When 2 observers were available, the average of the 2 scores was calculated. A professional video company was employed to film activities at each of the hospitals on the day of the disaster drill. Although various areas of the hospital were filmed, the predominant focus was on the incident command center and capturing the interactions among its members. The videos were edited, transferred to DVDs, and sent to MedTeams, whose staff were blinded to the drill and site survey results, for analysis and scoring of teamwork behaviors. To assess teamwork behaviors, MedTeams uses a team dimension rating scale based on the 5 team dimensions of the behaviorally anchored rating scales and an overall score, which is a mean of the 5 team dimensions. The range of possible scores for each of the team dimensions was 1 to 7. “Team dimension Annals of Emergency Medicine 197 Assessing Hospital Disaster Preparedness rating” is the term applied to the process of observing team behavior and assigning ratings to each of the 5 behaviorally anchored rating scale team dimensions.29 Each team dimension has specific criteria that are used for scoring purposes. The first team dimension assesses how well the team structure was constructed and maintained. For example, the observer is asked to rate how efficiently the leader assembled the team, assigned roles and responsibilities, communicated with each of the team members, acknowledged contributions of team members to team goals, demonstrated mutual respect in all communications, held everyone accountable for team outcomes, addressed professional concerns, and resolved conflicts constructively.29 The second team dimension assesses planning and problemsolving capability. Hospital Emergency Management Planning Exercises and Training Assignment Observations include whether team members were engaged in the planning and decisionmaking process, whether protocols were established to develop a plan, whether team members were alerted to potential biases and errors, and how errors were avoided and corrected.29 The third team dimension evaluates team communications. Observations include whether situational awareness updates were provided, whether a common terminology was used, whether the transfer of information was verified, and whether decisions were communicated to team members.29 The fourth team dimension assesses the management of team workload. The observer records whether there was a teamestablished plan to redistribute the workload, integrating individual assessments of patient needs, overall caseload, and updates from actions of team members.29 The final team dimension describes team improvement skills. Recorded observations include whether there were shift reviews of teamwork, whether teamwork considerations were included in educational forums, and whether situational learning and teaching were incorporated into such forums.29 Although behaviorally anchored rating scale descriptions specify distinct clusters of teamwork behaviors, there is some inevitable overlap across the 5 team dimensions. The behaviorally anchored rating scale describes concrete and specific behaviors for each team dimension and provides anchors for the lowest, middle, and highest values (standards of judgment). Additionally, the behaviorally anchored rating scale delineates criteria for assigning a numeric value to the rater’s judgment, and each of the 5 dimensions is rated on a numeric scale of 1 to 7, in which 1 is very poor and 7 is deemed superior.29 Primary Data Analysis Data obtained from the on-site survey and drill evaluation tool were recorded on data collection forms. All data were stored in an Access database (Access 2003; Microsoft Corporation, Redmond, WA). The database was translated into SAS format using DBMS/Copy (DataFlux Corporation, Cary, NC). The statistical analysis was performed using SAS, version 9.1 (SAS Institute, Inc., Cary, NC), and Stata, version 9.2 (StataCorp, College Station, TX). 198 Annals of Emergency Medicine Kaji, Langford & Lewis Table. Results of 3 methods of assessing hospital disaster drill performance. Hospital Number* On-site Survey (1–215) (%)† Modified AHRQ Score in ICC (1–45) (%)† MedTeams ICC Score (1–7) (%)† 1 2 3 4 5 6 155 (72) 155 (72) 186 (87) 159 (74) 166 (77) 152 (71) 31 (69) 19 (42) 27 (60) 34 (76) 24 (53) 26 (58) 5 (71) 4 (57) 4.8 (69) 5 (71) 4.2 (60) 5 (71) ICC, Incident command center. *Note that there was only 1 observer deployed to the ICC at hospitals 1 and 4, whereas the remaining 4 hospitals had 2 observers simultaneously deployed to the ICC, and .. 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